Egyptians Civilizations
Built irrigations and granaries for proper storage of foods Practice of prophylaxis by the medicine man and high priest Emphasize on personal hygiene Sanitation measures (removal of refuse and fumigation esp. during epidemic)

Hebrews
Founders of public hygiene Moses ± Father of Sanitation Mosaic Health Code ± focus on individual, family and community hygiene

to the field of sanitations Appointing public health medicine officer Establish hospitals which emphasize on preventive and curative aspects of care

Development of Public Health Nursing as a World Movement
Early Christian Period (1st Century) Middle Ages Renaissance Early 19th Century

Early Christian Period st Century) (1
Order

of Deaconesses

Visiting

nurse Forerunners of community health nurses Endeavored to practice the corporal works of Mercy (feeding the hungry, caring for the sick, burying the dead)

Middle Ages
Beguines
worked

of Flanders

as nursing sister in the

hospital gives care to the sick in their homes staying with the dying and consoles the family

Renaissance

St. Vincent the Paul ± introduce modern principles of visiting nursing and social services
Taught that discrimination is harmful Emphasized the concept of helping people help themselves Organized Daughters of Charity Family is the basic unit of service Recognized the importance of supervision of those who render services of the sick

Early 19th Century
Pastor Theodor Fliedner ± a German pastor. went on tour to raise fund for a program on social work. Frederika Munster Fliedner ± organized Women¶s Society for visiting and nursing the sick poor in their homes
.

Development of Modern Public Health Nursing
.

Period of Empirical Environmental Sanitation (1840-1890) (1840 Emphasized
Removal
measures to control communicable diseases:
of refuse waste Clean-up campaigns of prisons and Cleanasylum Improvement of working conditions of women and children
.

private duty. and district nurse
.William
Rathborne ± Father of modern district nursing ± organized training school for nurses. hospital.

Period of Scientific control of communicable diseases (1890-1910) (1890-
Application of bacteriology and immunology
.

Period of Health Education (1910 to present)
Emphasized on education for prevention of diseases with active cooperation of individual in health action
.

Public Health Nursing in the Philippines
PrePre-Spanish Era ± no records Spanish Regime (1591-1898) (1591
Bro. provincial and national health officers
. Juan Clemente (1577) ± started public health services Introduction of water sanitation Introduction of small pox vaccine Creation of position of district.

Act No. 309 created Provincial and Municipal Boards of Health
.American Regime (1898-1946) (1898 1898 ± creation of Board of Health for physicians 1899 ± appointment of the 1st commissioner of health 1901 ± Act No. 157 created Board of Health for the City of Manila.

. 1407 (reorganization act) abolish Board of Health and was taken over by the Bureau of Health under the Department of Interior 1906 ± creation of Bureau of Health 1912 ± Fajardo Act (Act No.1905 ± Act No. In the same year public health nursing in the Philippines started. 2156) created Sanitary Division.

Perlita Clark took charge of the public health nursing 1917 ± 4 nursing graduates from Manila were employed to worked in the city school
.
1915 ± Bureau of Health was renamed Philippine Health Service. Reorganization Act No. 1916 to 1918 ± Ms. nurseRosario Pastor. headed by nurse-physician Dr. 2462 ± created the office of General Inspection.

Manila when visiting nurse Ms. Balbina Basa was assigned to make a house to house visit. The program was later extended to the province incorporation with Bureau of Public Welfare
. Philippine National Red Cross introduced the operation of puericulture. hold clinic and dispensary work with special emphasis on maternal and child care.
1919
Public health nursing was inaugurated in Tondo.

Carmen del Rosario was appointed as the first Filipino nurse under the Bureau of Health 1923 ± established 2 government schools of nursing: Zamboanga General Hospital School of Nursing and Baguio General Hospital in Northern Luzon.Ms. In later year 4 more school were establish
.

4007.1928 ± Fist convention of nurses were held 1933 ± Reorganization Act No. the Division of Maternal and Child Health of the Public Welfare Commission was transferred to the Bureau of Health 1940 ± The Department of Health and Welfare was created
.

the Bureau of Health increased the number of public health nurse. Mrs. technical assistant in nursing of the Ministry of Health and concurrent president of Filipino Nurses Association recommended the creation of a nursing office in the Ministry of Health.
.
Japanese Regime (1942-1945) ± Public health (1942nursing were interrupted 1946 ± after world war. Genara de Guzman.

Era of Republic of the Philippines (1949 to present) 1947 ± Reorganization of government offices under EO No. 94: Bureau of Public Welfare to the office of the president and renamed as Department of Health 1953 ± the office of Health Education and Personnel Training was created
.

and Bureau of Food and Drug 1986 ± The Ministry of Health became Department of Health again 1991 ± RA 7160 (Local Government Code).
1982 ± Executive Order No. the health education and manpower development service was created. 851.
. Devolution ± transfer of power from the national to local government which aimed to built their capabilities for self-government and developed a selfselfself-reliant communities.

1993 to 1998 ± National League of Philippine Government Nurses was organized 1996 ± Primary Health Care as a strategies to attain Health for all by the year 2000 1999 ± Creation of National Health Planning Committee and Inter-Local InterHealth Zones through EO 205
.

May 24. precision and effective coordination towards improving the efficiency. nursing positions were devolved 1999 to 2004 ± Health Sector Reform Agenda of the Philippines was launched 2005 ± Fourmula One for Health to ensure speed. effectiveness and equity of health care delivery
. redirecting the function and operations of the DOH. Estrada.1994 ± EO 102 signed by Pres.

(Freeman)
.Definitions and Focus: PHN/CHN
Both
term are often interchange but synonymous PHN is a synthesis of public and nursing practice.

PHN
is a field of professional practice in nursing and in public health in which technical nursing. interpersonal.
. analytical and organizational skills are applied to problems of health as they affect community.

These skills are applied in concert with those of other persons engaged in health care.
. through comprehensive nursing care of families and other groups and through measures for evaluation or control of threats to health. for health education of the public and for mobilization of the public for health action.

C. prolonging life. control of communicable diseases.Public Health
According to Dr. education of individuals in personal hygiene«. WINSLOW PUBLIC HEALTH ± is the science and art of preventing disease.E. promoting health and efficiency through organized community effort for the sanitations of the environment.
.

and the development of the social machinery to ensure everyone a standard of leaving adequate for the maintenance of health. so organizing these benefits as to enable every citizen to realize his birthright of health and longevity.
.« the organization of medical and nursing services for early diagnosis and preventive treatment of disease.

.According to WHO PUBLIC HEALTH ± is the art of applying science in the context of politics so as to reduce inequalities in health while ensuring the best health for the greater number.

the core element of governments¶ attempts to improve and promote the health and welfare of their citizens.
.
Therefore.

in relation to environmental hazards Promotion of health and equitable health gain
.
Core business of PUBLIC HEALTH
Disease control Injury prevention Health promotion Healthy public policy.

Essential Public Health Functions
Health situation monitoring and analysis Epidemiological surveillance/disease prevention and control Development of policies and planning in public health Strategic management of health systems and services for population health gain Regulation and enforcement to protect public health
.

social participation and empowerment Ensuring the quality of personal and population based health services Research.Human resources development and planning in public health Health promotion. development and implementation of innovative public health solutions
.

Public Health Nursing
Made great contributions to the improvement of the health of the people Leaders in providing quality health care services to communities. First level of health workers to be knowledgeable about new public health technologies and methodologies. Usually the first to be trained to implement new programs and apply new technology.
.

O
Demarcates the line of nursing action
To serve both well and ill in the community Right to medical care and right to nursing care are implied in the fundamental human rights
A changing trend in community care gave birth to COMMUNITY HEALTH NURSING
.H.NURSING UNDER W.

prevention disease and disability and rehabilitation Achieved through teaching and delivery of health care
GOAL: raise the level of health of the citizenry
.Community Health Nursing
Maglaya. Freeman
Utilization of nursing process for clientele Concerned with the promotion of health (optimal level of functioning). Jacobson.

Basic Concept of CHN
Primary focus on health promotion and disease prevention Extend the benefits not only to individual but the whole family and community and special population CH nurse are generalist in terms of their practice from womb to tomb
.

) THC (sophisticated medical centers)
CHN practice requires knowledge from biological. social and other related sciences Continuous nursing process is applied
.
Contact with clients is a long term at all levels of health care
PHC (community) SHC (regional/provincial/district municipal/local hosp.

families.Basic Principles of CHN
Recognized needs of communities. groups and individuals CHN nurses has full knowledge of the objective and policies of the agency she represent (facilities goal achievements)
Set priorities Goal setting Objective should be client centered and SMART Action Evaluation
.

customs and beliefs of client Health education and counseling are vital role of CHN Collaborative work relationshiprelationshipcoordinator of health service
. creed and sociosocioeconomic status and respect values.Focus care on the family Available to all race.

Monitoring or periodic evaluation of health services (accurate recording and reporting for evaluation purposes) Opportunities of continuous education program to upgrade nursing practice Make use of available community health resources or the indigenous and existing community resource appropriate technology CH nurse has active participation in the community
.

. It is influenced by the nature of health needs of the population. specific goals of the health care system and the attitudes and practices of the nurse in providing care.Role of Public Health Nurse
The
roles are varied and dynamic.

Clinician
(health care provider) ± takes care of sick people at home or in the RHU.
Home
visit PHN Bag
.

Home visit
PURPOSE
Give nursing care to sick. and children Assess living condition Provide health education Promote health and use of referral for utilization of community health
. mothers.

PRINCIPLE
State purpose and objective Use records and reports Give priority to essential needs Planning and delivery of care involves clients Plan should be flexible
.

PHN Bag
Essential and indispensable equipment which contains basic medication and articles necessary for giving care.
Should observe proper bag technique principle
Prevent
spread of microorganism Save time and efforts for nursing procedure Should show effectiveness of total care given to clients
.

Case
Manager
Assist
clients to make decisions about appropriate health care services and to achieve service delivery integration and coordination
.

lobby for beneficial public policy and stimulate supportive community action for health
. Advocate
Seek
to promote an understanding of health problems.

sociosocio-civic organizations and sectoral groups
. Partner/
To
Collaborator
get people together in order to address problems or concerns Works with people¶s and health organizations educational institutions.

Responsibility of CHN
Be a part in developing and overall health plan. its implementation and evaluation for communities. Provide quality nursing service to all level of clientele Maintain coordination/ linkages with other health team members in the provision of public health service
.

Conduct researches relevant to CHN services to improve provision of HC Provide opportunities for professional growth and continuing education for staff development
.

COMMUNITY HEALTH AND DEVELOPMENT CONCEPTS. PRINCIPLES AND STRATEGIES
.

mental and social wellwellbeing and not merely the absence of disease or infirmity (WHO.1946)
.CONCEPTS AND DEFINITIONS
Health
is a state of complete physical.

All people should have access to basic resources for health:
Peace. and a stable ecosystem and sustainable resources use. food and shelter.A fundamental human right (Ottawa Charter ± 1986).
. adequate resources.

MODELS OF HEALTH
.

The absence of one or more of the ³five D¶s´ Death Discomfort Disease Disability Dissatisfaction * If you are not sick or dying.Medical Model
Health is the state of being free of signs or symptoms of disease and illness. you are considered to be in the best attainable state of health.
.

Beliefs ± Feeling ± Behavior
.Health Belief Model
Health
and illness is affected by genetic characteristics and the cultural values and beliefs learned and practice by the families and communities.

.
.Agent ± Host ± Environment Model
The agent. is useful for examining the cause of disease in an individual.hostagent.hostenvironment model of health and illness for community health (Leavell and Clark ± 1965).

´
ENVIRONMENT (factors external to the host)
AGENT (microorganism or chemical substance)
HOST (living organism capable of being infected by the agent)
.³health is an ever changing state.

with high level wellness and death being on opposite ends of a graduated scale.
. or continuum.HealthHealth.Illness Continuum
Health is a constantly changing state.

Rodale).High Level Wellness
High level wellness refers to functioning to one¶s maximum potential while maintaining balance of purposeful direction in the environment(1977.
.

Needs Fulfillment Model
Health is a state in which needs are being sufficiently met to allow an individual to function successfully in life with the ability to achieve the highest possible potential
.

Role Performance Model
Health is the ability to perform all those roles for which on has been socialized.
.

PRIMARY HEALTH CARE
.

and a range of approaches for addressing priority health needs and the fundamental determinants of health.
30 years ago. the Declaration of Alma-Ata Almaarticulated primary health care as a set of guiding values for health development.
. a set of principles for the organization of health services.

6-
. Alma-Ata). September 6-12. Almaty (formerly Alma-Ata). presently in Kazakhstan.
The Declaration of Alma-Ata was Almaadopted at the International Conference on Primary Health Care. 1978.

.
It expressed the need for urgent action by all governments. all health and development workers. and the world community to protect and promote the health of all the people of the world.

It was the first international declaration underlining the importance of primary health care. The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of "Health for All".
.

Primary health care. abbreviated as PHC. often care. is
"essential health care based on practical. scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of selfselfdetermination"
.

1979. which was signed by former President Marcos on October 19.
.
In the Philippines. primary health care was implemented under Letter Of Instruction 949 .

MISSION
To strengthen the health care system by increasing opportunities and supporting the conditions wherein people will manage their own health care
.

GOAL
Health for All SELF-RELIANCE SELF
ability to stand on their own self-sufficiency self In
accordance with the goal of the Department of Health which is.
Framework People¶s empowerment and partnership is the key strategy to achieve the goal ³Health for all Filipinos and Health in the hands of the people by the year 2020´.
.

ACCEPTABLE AND AFFORDABLE. AVAILABLE.GENERAL PRINCIPLES AND STRATEGIES
HEALTH AND DEVELOPMENT ARE INTERRELATED ESSENTIAL HEALTH SERVICES MUST BE ACCESSIBLE. GENUINE PEOPLE¶S PARTICIPATION IS ESSENTIAL ± Community Participation
.

Convergence (meeting) of health, food, nutrition, water, sanitation, and population services. Integration of PHC into national, regional, provincial, municipal and barangay development plans.

Coordination

of activities with economic planning, education, agriculture, industry, housing, public works, communication and social services. Establishment of effective health referral system

ESSENTIAL HEALTH SERVICES MUST BE ACCESSIBLE, AVAILABLE

Health services delivered where the people are Use of indigenous volunteer health worker as a health provider with a ratio of one community health worker per 10-20 10households Use of traditional medicines with essential drugs

GENUINE PEOPLE¶S PARTICIPATION IS ESSENTIAL

Awareness building and consciousness rising on health- related issues. healthPlanning, implementations, monitoring and evaluation done through small group meeting (10-20 household cluster) (10-

Selection of community health workers by the community. Formation of health committees. Establishment of community health organization at the parish or municipal level. Mass health campaigns and mobilization to combat health problems

SELFSELF-RELIANCE

Use of local resources Training of community in leadership and management skills Incorporation of income generating projects, cooperatives and small scale industries.

education.SOCIAL MOBILIZATION
Establishment of an effective health referral system MultiMulti-sectoral and interdisciplinary linkage Information. communication support using multi-media multiCollaboration between government and nonnongovernment organizations
.

.DECENTRALIZATION
Devolution (RA 7160) Transfer of power from the national government to local government unit Reallocation of budgetary resources Reorientation of health professionals on Primary Health Care Advocacy for political will and support from the national leadership down to the barangay level.

preventive. BASIC AND ESSENTIAL HEALTH SERVICES
Training design and curriculum based on community needs and priorities Attitude.
. curative and rehabilitative health care Regular monitoring and periodic evaluation of community health worker performance by the community and health staff. knowledge and skills developed are on promotive.PROVISION OF QUALITY.

that health is a basic right of every individual and not just to those who can afford to pay their own health care
.MAJOR ELEMENTS
1. Use of Appropriate Technology
This emphasizes equity and justice.

Criteria in determining use of appropriate technology Effectiveness and safety Complexity ± simple and easy to apply Cost Scope of technology ± effective. appropriate Acceptability Feasibility ± compatible with the local setting
.

As such. it is necessary to unify health efforts within the health organization it self and with other sectors concerned.Intersectional Linkages
Primary Health Care forms an integral part of the health system and the over all social and economic development of the community. It implies the integration of health plans with the plan for the total community development.
.

Sectors
most closely related to health includes those concerned with:
Agricultural Education Public
works Local government Social welfare Population control Private sectors
.

There is now widely accepted pyramidal organization that provides level of services starting with primary health and progressing to specialty care. the acceptance or primary health care necessitates the restructuring of the health system to broaden health coverage and make health service available to all.
.Intrasectoral Linkage
In the health sector. Primary care is the hub of the health system.

.HEALTH CARE FACILITIES
1. their sub-centers. Primary Level of Health Care Facilities
This are the rural health units. large industrial firms for their employees Community hospitals and health centers operated by Philippine Medical care Commission and other health facilities operated by voluntary religious and civic groups Health services offered: caters to individuals in fair health and to patients with disease in the early symptomatic stages. malaria eradication units operated by the DOH Private clinics operated by Philippine medical Association. chest subclinics.

These are specialized national hospital. facilities and personnel to treat effectively. Tertiary Level of health Care Facilities
These are highly technological and sophisticated services offered by medical centers and large hospitals.
3. Health services offered: for clients afflicted with diseases which seriously threaten their health and which requires highly technical and specialized knowledge.
.

Intermediate level General Medical Practitioners. Midwifes
1st source of professional health care Attend to health problems beyond the competencies of the village workers Provides support to the front line health workers in term of supervision. training. PHN. referral services and supplies through linkages with other sectors
.

Health Personnel of first line hospitals Physicians with specialty area. Provide back-up health services for cases backrequiring hospital or diagnostic facilities not available in health care
. nurses and dentists
Establish close contact with the village and intermediate level health workers to promote the continuity of care from hospital to community to home.

HEALTH PROMOTION
Health promotion is a process of enabling people to increase control over the determinants of health and thereby improve their health. WHO (1986) Ottawa Charter Participation is essential to sustain health promotion action
.

and Mediating between the different interests in society in the pursuit of health
. Enabling all people to achieve their full health potentials.STRATEGIES FOR HEALTH PROMOTION
Advocacy for health to create the essential conditions for health.

Health Promotion Model (Nola Pender.´
. ³ If a behavior has been used before and becomes a habit.1996)
Individual characteristics and experiences can be useful in predicting if an individual will incorporate and use health related behaviors. it is more likely to used again.

accompanied by developing associated strategies to perform the value behavior.
BehaviorBehavior. beliefs and relationships ± major motivators for engaging in health behaviors.specific knowledge. A health related behavior is initiated by committing to a plan of action.
.

whereas a person with low selfself-efficacy would harbor feelings of hopelessness.SelfSelf-efficacy
It is a belief that one has the capabilities to execute the courses of actions required to manage prospective situations.
. Example:
A person with high self-efficacy may engage selfin a more health related activity when an illness occurs.

Therefore:
Self efficacy is the ability or the power to produce an effect/ change.
.

and challenges.
.Psychologist Albert Bandura has defined selfself-efficacy as one's belief in one's ability to succeed in specific situations. tasks. One's sense of self-efficacy can play a selfmajor role in how one approaches goals.

. people with high self-efficacy: selfare those who believe they can perform well are more likely to view difficult tasks as something to be mastered rather than something to be avoided.
According to Bandura's theory.

.How self-efficacy affects human selffunction
Choices regarding behavior
People will be more inclined to take on a task if they believe they can succeed. People generally avoid tasks where their self-efficacy selfis low. but will engage in tasks where their selfself-efficacy is high.

than those with low efficacy.
.
Motivation
People with high self-efficacy in a task are selfmore likely to make more of an effort. and persist longer.

Thought patterns & responses
Low self-efficacy can lead people to believe selftasks are harder than they actually are. People with high self-efficacy often take a selfwider overview of a task in order to take the best route of action.
.

where a person with low self-efficacy will attribute failure to selflow ability.People with high self-efficacy are shown to be selfencouraged by obstacles to make a greater effort. Self-efficacy also affects how people respond Selfto failure. A person with a high self-efficacy will attribute selfthe failure to external factors.
.

SelfSelf-efficacy beliefs are cognitions that determine whether health behavior change will be initiated. how much effort will be expended. Self-efficacy influences the effort one puts Selfforth to change risk behavior and the persistence to continue striving despite barriers and setbacks that may undermine motivation. and how long it will be sustained in the face of obstacles and failures.
.

& Schwarzer.g.
SelfSelf-efficacy is directly related to health behavior." or "I intend to quit smoking altogether"). but it also affects health behaviors indirectly through its impact on goals. SelfSelf-efficacy influences the challenges that people take on as well as how high they set their goals (e. 2005). A number of studies on the adoption of health practices have measured selfselfefficacy to assess its potential influences in initiating behavior change (Luszczynska. "I intend to reduce my smoking.
..

TYPES OF HEALTH PROMOTIONAL ACTIVITIES
HEALTH EDUCATION (information dissemination)
Use of variety of media to offer information to the public about the particular lifestyle choices and personal behavior. the benefits of changing that behavior and the improvement of quality of life
.

Jakarta Declaration on Leading Health Promotion into the 21st Century (1997)
.

Setting for health offer practical opportunities for the implementation of comprehensive strategies.
. Participation is essential to sustain efforts. Health literacy fosters participations.Strategies and action areas are relevant for all countries
Comprehensive approaches to health development are most effective.

ACTIVITIES FOR HEALTH PROMOTION
HEALTH APPRAISAL WELLNESS ASSESSMENT PROGRAM
Appraise individuals of their risk factors that are inherited in their lives/family in order to motivate them to reduce specific risk and develop positive health habits Wellness assessment programs are focused on more positive methods of enhancement
.

LIFE-STYLE AND BEHAVIOR CHANGE LIFEPROGRAM
Basis for changing behavior Geared towards enhancing the quality of life and extending the life span
.

WORKSITE WELLNESS PROGRAM
Includes programs that serve the needs of the persons in their work places
.

land. water etc.
ENVIRONMENTAL CONTROL PROGRAM
Developed to address the growing problem of environment pollution such as air.
.

but also to arrest it progress and reduce its consequences once established. WHO (1984)
.DISEASE PREVENTION
Disease prevention covers measures not only to prevent the occurrence of diseases. such as risk factor reduction.

. disease prevention is defined saparetly. Although there is frequent overlap between the content and strategies.Disease prevention is sometimes used as a complementary term alongside health promotion.

.
Disease prevention is considered to be actions which usually emanates from health sector. dealing with individuals and populations identified as exhibiting identifiable risk factors. often associated with different risk behaviors.

Example:
Health
education about accident and poisoning
. Decreases the risk or exposure of individual and community to disease.LEVELS OF DISEASE PREVENTION
PRIMARY LEVEL Directed towards preventing the initial occurrence of disease.

stress management. exercise requirements. protection against occupational hazard. Immunization Risk assessments for specific disease Family planning services and family counseling Environmental sanitation and provision of adequate housing. recreation and work conditions
. Health
education about standards of nutrition and growth and development.

SECONDARY LEVEL Focus on early identification of health problem and prompt intervention to alleviate health problems.
Example
Screening
surveys
. Includes prevention of complications and disabilities.

when defect or disability is fixed or determined to be irreversible Focus to help rehabilitate individuals and restore hem to an optimal level of functioning within the constraints of the disability
.TERTIARY LEVEL Begins after illness.

Example:
Referring
client to a support group Teaching diabetic client to prevent complications Referring client to rehabilitation center
.

2004) 2004)
. sociocontext.COMMUNITY
Comunitas ± latin word for group of individuals A community is a group of people sharing common geographical boundaries and/or common values and interest/ its functions within a particular socio-cultural context. (Maglaya.

A community is a collection of people who interact with each other and whose common interest or characteristics give them a sense of unity and belonging. belonging. 1996) 1996)
. (Spradley & Allender.

RURAL
town .province low density area having simple life close family ties people usually spend time in farming and fishing for foods
.

URBAN
suburbs a combination of an urban and rural community thick population heterogeneous with mixed family ties
.SUB .

small scale institution Bayanihan is common Many Agricultural/ non professional Many Usually small Based on personal attachment
6. wide scale institution. Density of population 2. Social structure Greater There is very wide range of income distribution. Cultural activities 8. credentials. achievements. less in membership. Choice
. popularity
5. Nature of occupation 9. few are rich and majority of the people belong to a lower income Highly specialized. Domestic animals 10.Difference between Rural and Urban Community
Criteria 1. Size 11. more or less there is even distribution of wealth Rural Thick dense Face to face contact but usually very casual Urban 3. Social institution
Not very specialized. Activities 7. professionals Few Generally big Based on educational attainment. more membership Paid services Few White color jobs. Social mobility 4. Social relationship Less dense Strong and have close ties and interaction with the community Lesser No significant difference of wealth.

achieve a working consensus on the agreedagreed-on goals. collaborate effectively in the required actions
. concerns and problems of the community.HEALTHY COMMUNITY
A community which is able to: collaborate effectively to identify the needs.

air to breath. cooperation.CHARACTERISTIC OF A HEALTHY COMMUNITY
prompts its members to a degree of awareness uses its natural resources eg. values openly recognize the existence of subgroups and welcome their participation prepared to meet crises
. eg.

able to solve problems has an open channel of communication seek to make its system of community resources are available for all encourage maximum participation in decision making promotes high level of wellness
.

Components of a Community
Core Sub system
.

CORE
represents the people that make up the community
Social class Ethnicity Culture Beliefs Traditions
.

materials. arrangement
Are there enough housing facilities available? Are there housing laws/regulations governing the people?
.HOUSING
What type of housing facilities are there in the community?
Structure.

acceptable health care services
. Physical environments promote health. care. safety. Safe water and nutritious food Families provide members with basic needs Available. order and cleanliness. People work together to attain goals. accessible. cleanliness.Elements of a Healthy Community
People are partners in health care. goals. affordable.

income. social justice and equity. food.
. shelter. education. a stable ecosystem.Community Health
According to Dever :
fundamental to community health are peace. equity. sustainable resources.

Informed political issue. action and healthy pubic policies are essential to healthy community.
According to Flynn: Flynn:
responsibility for health is widely shared in the community with collaborative decisiondecisionmaking about health issue.
. community.

Oppression especially of society. Political jurisdictions have the live. power and authority to regulate the environment. differential treatment in various classes of society affects health.
. Examples are safety. empowerment. oppression and people empowerment. health. the poor. environment. Increase in crimes and the lack of safety in streets and even in homes are major concerns of society.POLITICAL
Politics greatly influence the social climate in which people live.

However. the middle and upper income group have also very pressing health problems such as drug abuse and lifelifestyle diseases.
. This is because. people from the lower income groups tent to have proportionately greater number of illnesses and health problems than those in the higher income groups.SOCIOSOCIO-ECONOMIC
Families from the lower income groups are the ones mostly served in public health services and by the community health workers.

. Early knowledge of transmitted.HEREDITARY
Understanding of genetically influenced diseases is increased through knowledge about the nature of the genetic materials and about the process by which genetic traits are transmitted. the genetic risk makes it possible to anticipate and counteract genetic outcomes thus enabling the medical team to prepare for necessary therapeutic intervention. intervention.

. made.ENVIRONMENT
The menace of pollution has been growing over the years and has greatly affected the health of the people. are largely man made. The diseases today people.

heritage. These may has. by their culture and ethic heritage. exercise. The people¶s lifestyle. to a large extent. substance abuse and lack of exercise.
. intake of alcoholic drinks. be in form of smoking.BEHAVIORS/ ATTITUDE/LIFE-STYLE ATTITUDE/LIFE
A person¶s level of functioning is affected by certain habits that he has. health care and child rearing practices are shaped.

Philippines.
. Although promotive and preventive health measures are emphasized in community health the availability and accessibility of curative and rehabilitative services also affect people¶s health. sustainable and affordable. primary health care is a partnership approach to the effective provision of essential health services that are community based. acceptable.HEALTH CARE DELIVERY SYSTEM
HEALTH CARE DELIVERY SYSTEM. accessible. In the SYSTEM. affordable. health.

COMMUNITY HEALTH DEVELOPMENT PROCESS
.

´ WHO defined health as ³A complete state of mental. HEALTH. DEVELOPMENT
WHO defined community as ³ A social group determined by geographical boundaries and/or common values and interests. physical.´
. and social well-being welland not merely the absence of disease or infirmity.COMMUNITY.

Development is defined as:

a change, a process of unfolding from an ununmanifested condition to more advance or effective condition. In these process the qualities reveals possibilities, capabilities emerge, and potentials are realized.

A multi-dimensional process involving major multichanges in social structures, population, attitudes and national institutions, as well as the acceleration of economic growth, reduction of inequality and eradication of absolute poverty. The goal of development is to have a better life. (Teodoro, 1978)

According to NEDA: Development includes consumption of basic goods and services such as health and education and the generation of more productive employment and reduction of inequalities in income and access.

Community Development

is a process designed to create a condition of economic and social progress for the whole community with its active participation and fullest possible reliance on the community initiatives.

How can we say that the community is developed?
the people are working together have the vision know how capabilities and experience to confront and solve problems of under development

Community development principle is committed to the services of the people to become selfselfreliance. the health of the community depends on its ability to work toward common health goals and upon adequate distribution of health resources to all members. Therefore. reliance.
.

Furthermore.
. Organized community effort to prevent disease and promote health is valuable and effective.

.WELFARE APPROACH
This is an immediate and/or spontaneous response to ameliorate the manifestation of poverty. especially on the personal level. which are beyond the control of the people. Assumes that poverty is caused by bad luck. natural disasters and certain circumstances.

which adopts the western mode of technological development.MODERNIZATION APPROACH
This is also referred to as the project development approach. Also considered a national strategy. Introduces whatever resources are lacking in a given community.
.

Believes that poverty is due to lack of education.
. lack of resources such as capital and technology.Assumes that development consists of abandoning the traditional methods of doing things and must adopt the technology of industrial countries.

TRANSFORMATORY/ PARTICIPATORY APPROACH
This is the process of empowering/ transforming the poor and the oppressed sectors of society so that they can pursue a more just and humane society.
.

domination and other unjust structure.
. oppression.
Believes that poverty is caused by prevalence of exploitation.

COMMUNITY ORGANIZING PARTICIPATORY ACTION RESEARCH (COPAR)
.

. individualistic.
A social development approach that aims to transform the apathetic. participatory and politically responsive community. and voiceless poor into a dynamic.

sustained and systematic process of building people organizations by mobilizing and enhancing the capabilities and resources of the people for the resolution of their issues and concerns towards affecting change in their existing oppressive and exploitative conditions.
. liberated. participatory.
A collective. transformative.

confidence to take action in respect to them and in doing so extends and develops cooperative attitudes and practices in the community. Develops objective.
.
A process by which community identifies its need and objective.

.
A continuous and sustained process of educating the people to understand and develop their critical awareness of their existing condition. working with the people. collectively and efficiently on their immediate and long term problems. and mobilizing the pursue to develop their capability and readiness to respond and take action on their immediate needs toward solving their long term problems.

IMPORTANCE OF COPAR
COPAR ± is an important tool for community development and people empowerment.
. as this helps the community workers to generate community participation and developmental activities.

COPAR ± prepares people/clients to actually takeover the management of development programs in the future.
.

community resources are mobilized for community services.
COPAR ± maximizes community participation and involvement.
.

exploited and deprived sectors are open to change.PRICIPLES OF COPAR
People especially the most oppressed.
. and able to bring about change. have the capacity to change. COPAR should be based on the interest of the poorest sectors. COPAR should lead to self-reliant community selfand society.

PROCESSES AND METHODS USED
A PROGRESSIVE CYCLE OF ACTIONACTIONREFLECTION-ACTION (ARA) ± which REFLECTIONARA) begins with small. local.
. and concrete issues identified by the people and the evaluation and reflection of actions taken by them.

CONSCIOUSNESS RISING ± through experiential learning is centered to the COPAR process because it places emphasis on learning that emerges from concrete action and which enriches succeeding action.
.

.
PARTICIPATORY AND MASS BASED ± it is primary directed towards and based in favor of the poor. the powerless and the oppressed.

emerged and are tested through action rather than appointed or reelected by some external force or entity.
GROUP CENTERED AND NOT LEADER ORIENTED ± leaders are identified.
.

.PREPRE-ENTRY PHASE
The initial phase of the organizing process where the community organizer looks for communities to serve or help. activities and strategies and time spent for it. It is considered the simplest phase in terms of actual outputs.

including all its activities and strategies for care and development.
Activities included:
Designing
a plan for community development. Preparing the health care worker.
.

Designing
criteria for the selection of site
Depressed Oppressed Poor Exploited
Actual
selecting the site for community care
.

ENTRY PHASE

Sometimes called the social preparation phase This includes the synthesis of the people on the critical events in their life, motivating them to share their dreams and ideas on how to manage their concerns and eventually mobilizing them to make collective action on these.

NOTE: Recognize the role of local authorities by paying them visits to inform them of their presence and activities. Health worker appearance, speech, behavior and lifestyle should be in kept in low profile and health workers should always serves as a role model. Avoid raising the consciousness of the community residents Work always with community member to identify potential leaders.

This phase signals the actual entry of the community worker/organizer into the community. She must be guided by the following:

Integration with the community Conduct of courtesy calls Conduct of information campaigns about the community health development programs Conduct of the community study and social investigation Provision of health and health related services, and Identification of potential leaders

NOTE: Recognize the role of local authorities by paying them visits to inform them of their presence and activities. Health worker appearance, speech, behavior and lifestyle should be in kept in low profile and health workers should always serves as a role model. Avoid raising the consciousness of the community residents Work always with community member to identify potential leaders.

CORE GROUP FORMATION PHASE

Once the community health nurse identifies the potential leaders, they were formed into a core group. The core group will be given the role of community organizer.

Integration with the core group members Deepening social investigation Training and education Mobilizing the core group

ORGANIZATION-BUILDING ORGANIZATIONPHASE

Entails the formation of more formal structures and the inclusion of more formal procedures of planning, implementing, and evaluating communitycommunity-wide activities.

. informal) to develop their ASK (attitude.
It is at this phase where the organized leaders or groups are being given trainings (formal. knowledge and skills) in managing their own concerns/programs.

Other community members are encourage to join and form a community organization
Pre-organization Pre-
building activities Organizing the barrio health committee Setting up community organization
Training and education for the organization
.

.SUSTENANCE AND STRENGTHENING PHASE
Occur when the community organization has already been established and the communitycommunity-wide undertakings.

.
At this point. implementing and evaluating their own programs. with the overall guidance from the community-widecommunity-wideorganization. the different committees setsetup in the organization-building phase are organizationalready expected to be functioning by way of planning.

CRITICAL STEPS IN BUILDING PEOPLE ORGANIZATION
INTEGRATION SOCIAL INVESTIGATION TENTATIVE PROGRAM PLANNING GROUNDWORK MEETING ROLE PLAYING MOBILIZATION OF ACTIONS EVALUATION REFLECTION ORGANIZATION
.

CRITICAL STEPS IN BUILDING PEOPLE ORGANIZATION
INTEGRATION ± a community organizer becoming one with the people in order to:
immerse himself in the poor community understand deeply the culture. leaders.
. rhythms and lifestyle of the community. history. economy.

collating. analyzing data to draw a clear picture of the community.
SOCIAL INVESTIGATION ± A systematic process of collecting. Also known as community study
.

.
TENTATIVE PROGRAM PLANNING ± Community organizer to choose one issue to work on in order to begin organizing the people.

The entry phase or sometimes called the social preparation phase.
.
GROUNDWORK ± Going around and motivating the people on something or an issues. A time to spot and develop potential leader.

MEETING ± Core group formation. People collectively ratifying what they have already decided individually. The meeting gives the people the collective power and confidence.
. Problems and issues are discussed.

.
ROLE PLAYING ± To act out the meeting that will take place between the leaders of the people and the government representatives.

MOBILIZATION OF ACTIONS ± Actual experience of the people in confronting the powerful and the actual exercise power.
.

. onongoing concerns to look at the positive values compared to the ideal. REFLECTION ± dealing with deeper.
EVALUATION ± determines whether the goal is met or not.

Occurs when the community organization has already been established and the community members are already participating in a community wide undertaking.
.
ORGANIZATION ± the result of many successive and similar actions of the people.

COMMUNITY HEALTH NURSING PROCESS
.

Assessment of Community Health Needs
Community Diagnosis A process by which the nurse collects data about the community in order to identify factors which may influence the illness and deaths of the population. To formulate a community health nursing diagnosis and develop and implement community health nursing interventions and strategies.
.

Steps involved:
Site selection Preparation of the community Statement of the objectives Determine the data to be collected Identify methods and instruments for data collection Finalize sampling design and methods Make time table
.

Population group
Vulnerable groups
Infants and young children School age Adolescents Mothers Male Old people
.

Health resources problems ± they may be describe in terms of lack or absence of manpower. mortality or fertility B.Community health problems are categorized as:
A. materials or institutions necessary to solve health problem
. money. Health status problem ± they may be described in terms of increased or decreased morbidity.

environmental and political factors that aggravate the illnessillnessinducing situation in the community
. Health related problems ± they may be described in terms of existence of social.c. economic.

health resources or health related problems magnitude of the problem ± this refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem modifiability of the problem ± this refers to the probability of reducing.Priority Setting
Criteria:
nature of the problem presented ±the problems are classified by the nurse as health status. controlling or eradicating the problem preventive potential ± this refers to the probability of controlling or reducing the effects posed by the problem social concern ± this refers to the perception of the population or the community as they are affected by the problem
.

VITAL AND HEALTH STATISTICS EPIDEMIOLOGY
.TOOLS USED IN COMMUNITY DIAGNOSIS: DEMOGRAPHY.

.Biostatistics
Demography
Study
of population size. composition and spatial distribution as affected by births and deaths and migration.

Sources
Census ± complete enumeration of the population
De
jure ±people were assigned to place where they usually live regardless of where they are at the time of the census De facto ±people were assigned to place where they physically present at the time of the census
.

Components
Population Size Population Composition Age distribution Sex ratio Population pyramid
.

Population Distribution
Urban ± Rural Crowding Index ± indicates the ease by which a communicable disease can be transmitted from one host to another susceptible host Population Density ± determine the congestion of the area/place
.

Fertility rate
Crude
birth rate General fertility rate
. deaths and common illness that is utilized to gauge the levels of health. illness and health services of a community.Vital statistics
The application of statistical measurements to vital events such as births.

Serves as indexes of the health condition obtaining in a community or population group.IMPORTANCE/IMPLICATION OF HEALTH STATISTICS
is a tool in planning. implementation and evaluating health programs.
It
.

Serves as basis for determining the success or failure of such services or actions. Provide
variables due as to the nature of health services or action needed.
.

000 Estimated mid year population
CBR =
.Crude Birth Rate (CBR )
Refers to the number of live birth/1000 population (fertility rate).
# of total registered live birth x 1.

000 Estimated mid year population
.
CDR = # of total deaths x 1.Crude Death Rate (CDR)
Refers to the deaths/1000 population. This also measures the force of mortality in a 1 year calendar.

000 # of registered live births
IMR =
.Infant Mortality Rate (IMR) Rate
Pertains to the number of death under 1 yr/ 1000 live births # of deaths under1 yr. X 1.

MMR = # of deaths related to pregnancy x 1.000 # of registered live births
.Maternal Mortality Rate (MMR)
Refers to the number of deaths related to pregnancy/ 1000 population.

NDR = # of deaths under 28 days x 1.000 # of registered live births
.Neonatal Death Rate (NDR)
Refers to the total number of deaths among individual below 28 days old.

Laguna has an estimated mid year population of 550 for the year 2007. MMR
. 15 babies dies during prenatal and post natal period. Nagcarlan. IMR. which occurs.Barangay Wakat. There are 7 mothers who died resulting from pregnancy. There are 75 deaths from any cause of disease. labor and delivery at the same year. Compute for the following: CBR. In the same year 250 live births are registered at the Municipal Hall. CDR. in the same year.

Deals only with new cases.Incidence Rate
This measures the frequency of occurrence of the phenomenon during a given period of time.
No. of new cases of a particular disease IR = registered during a specific period of time x 100.000 estimated population as of July of same year
.

Prevalence Rate
This measures the proportion of the population which exhibits a particular disease at a particular time.
. This can only be determined following a survey of the population concerned. Deals with the total number of old and new cases.

of new and old cases of a certain PR = disease registered at a given time total number of person examined at same given time
x 100
.No.

deformities or disabilities on human populations. death.
.Epidemiology
The study of the distribution of disease or physiological condition among human populations and the factors affecting such distribution. The study of the occurrence and distribution of health conditions such as disease.

IMPORTANCE AND USES OF EPIDEMIOLOGY IN PUBLIC HEALTH
Serve as backbone of the prevention of diseases
.

accidents.Uses of Epidemiology: according to Morris
To study the history of the health population and the occurrences of disease To diagnose the health of the community and the condition of people To study the working of health services with a view of improving them To estimate the risks of disease. defects and the chances of avoiding them
.

Steps in EPIDEMIOLOGICAL INVESTIGATION
Establish fact of presence of epidemic Establish time and space relationship of the disease Relate to characteristics of the group in the community Correlate all data obtained
.

Establish fact of presence of epidemic
Verify diagnosis Reporting Is there an unusual prevalence of the disease
.

Establish time and space relationship of the disease
Are the cases limited to or concentrated in a particular area Relation of cases by days of onset to onset of the first known cases (usually done in weeks)
.

occupation. school attendance. Relation of sanitary facilities Relation to milk and food supply Relation of cases to other cases and known carriers if any
.Relate to characteristics of the group in the community
Relation of cases to age. groups. sex. color. past immunization.

Correlate all data obtained
Summarize the data Draw final conclusion Establish source of epidemic and the manner of the spread Make suggestions as to the control and preventions of future outbreaks
.

the Millennium Development Goals.FOURmula ONE FOR HEALTH
OVEROVER-ALL GOALS: The implementation of FOURmula One for Health is directed towards achieving the following end goals. in consonance with the health system goals identified by the WHO. and the Medium Term Philippine Development Plan:
.

especially the poor. precision and effective coordination directed at improving the quality.
. effectiveness and equality of the Philippine Health System in a manner that is felt and appreciated by Filipinos. efficiency.General Objective:
FOURmula One for Health is aimed at achieving critical reforms with speed.

better. and sustained investments in health to provide equity and improved health outcomes.Health Financing
Objective To secure more.
. especially for the poor.

Strategies Mobilizing resources from extra budgetary sources Adopting a performance based financing system Coordinating local and national health spending Focusing direct subsidies to priority program Expanding the national health insurance program
.

especially those commonly used by the poor.Health Regulation
Objective Assuring access to quality and affordable health products. devices.
. facilities and services.

accreditation and certification Issuance of quality seals Assuring the availability of low-priced lowquality essential medicines commonly used by the poor
.Strategies Harmonizing licensing.

. This shall cover all public and private facilities and services. particularly the poor.Health Service Delivery
Objective Improving the accessibility and availability of basic and essential health care for all.

Strategies Designating providers of specific and specialized services in localities Ensuring availability of providers of basic and essential health services in localities Intensifying public health programs in targeted localities
.

Good Governance in Health
Objective Improve the health system both national and local levels Improve coordination across local health system Enhance effective private-public privatepartnership Improve national capabilities to manage health sector
.

.Institutionalizing a professional career track mechanisms for human resources for health Improving management support systems to enhance the delivery of health goods and services.

the responsibility for health promotion and protection has become a shared effort between the LGU¶s and the DOH.
Local Government Unit ± with the process of devolution (decentralization).
.

Private Sector . personnel training. Support research. counseling. Financing through financial assistance
.commercial organizations.This consists of both commercial and business organizations and nonnon. Their involvement includes:
Inputs provision which covers supplies and equipments/treatment and facilities Service delivery activities includes case findings/ treatment and follow-ups. environmental followsanitation and to manufacture goods. project monitoring and evaluation and development of IEC materials.

health resources development personnel.
. relief and disaster management and networking.NonNon-Government Organizations ± plays an important role in national and local development. human rights advocates. They assumed the role of policy and legislative advocates. research and documentation. organizers.

The National Health Care Plan
A long term plan for health The blueprint defining the country¶s health
.

with no longer life expectancy.Goal
To enable the Filipino population to achieve a level of health which will allow Filipino to lead a socially and economicallyeconomically-productive life. low maternal mortality and less disability through measures that will guarantee access of everyone to essential care.
. low infant mortality.

Broad objectives:
Promote equality in health status among all segments of society Address specific health problems of the population
.